Evaluation of the implementation of Medicaid health homes in New York City: The affordable care act in action

In 2011, New York State Department of Health (NYS DOH) redesigned the Medicaid service delivery program to implement a provision of the Affordable Care Act; the option for building person-centered systems of coordinated care. Entitled Health Homes, this model offers a comprehensive integration of medical and behavioral health care management to serve New York's most vulnerable and disenfranchised populations.

Three overarching goals guide Health Home implementation: Improve coordination of care and patient outcomes for 976,000 targeted NYS Medicaid beneficiaries, 42% with mental health and substance use issues; Reduce expenditures by decreasing avoidable hospital and ER usage; Utilize Health Information Technology (HIT) to create connectivity between each patient's interdisciplinary team of providers; sharing care plans and patient information in real time.

Implementation began in spring 2012, with several critical lessons learned, falling into six key areas: Becoming Operational; Enrolling Eligible Beneficiaries; Effective Financial Modeling; Establishing Relationships and Defining Roles; Developing Health Information Exchange; and Defining and Measuring Quality.

The Visiting Nurse Service of New York (VNSNY) was designated as a lead Health Home in the Bronx and Manhattan, in partnership with seven other medical and behavioral health providers. Our health home will, at full capacity, provide coordinated care to approximately 30,000 of the highest need Medicaid recipients; those with Serious Mental Illness, substance abuse issues, HIV/AIDS and multiple chronic medical illnesses, many with co-occurring diagnoses.

This presentation will outline the details behind each key implementation area, focusing on challenges, lessons learned and process measures/quality outcomes tracked and reported.